title: Organ donation as transition work: Policy discourse and clinical practice in The Netherlands.
abstract: An increasing number of patients become eligible for organ transplants. In the Netherlands, at the level of policy discourse, growing waiting lists are often referred to as a persistent "shortage" of organs, producing a "public health crisis." In this way, organ donation is presented as an ethical, social, and medical necessity. Likewise, policy discourse offers a range of seemingly unambiguous solutions: improving logistical infrastructure at the level of hospitals, developing organizational and legal protocols, as well as public information campaigns. Instead of taking these problem and solution definitions as given, we critically examine the relationship between policy discourse and clinical practice. Based on a historical review, first, we trace the key moments of transformation where organ donation became naturalized in Dutch policy discourse, particularly in its altruistic connotation. Second, based on in-depth interviews with medical professionals, we show how those involved in organ donation continue to struggle with the controversial nature of their clinical practice. More specifically, we highlight their use of different forms of knowledge that underlie clinicians' "transition work": from losing a patient to "gaining" a donor.
authors.affiliation: University of Vienna, Austria katharina.t.paul@univie.ac.at.
authors.forename: Katharina T
authors.initials: KT
authors.lastname: Paul
authors.affiliation: Erasmus Medical Center, The Netherlands.
authors.forename: Cees J J
authors.initials: CJ
authors.lastname: Avezaat
authors.affiliation: Erasmus Medical Center, The Netherlands.
authors.forename: Jan N
authors.initials: JN
authors.lastname: Ijzermans
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), The Netherlands.
authors.forename: Roland D
authors.initials: RD
authors.lastname: Friele
authors.affiliation: Erasmus University Rotterdam, The Netherlands.
authors.forename: Roland A
authors.initials: RA
authors.lastname: Bal
mesh_terms: D000533:Altruism; D006291:Health Policy; D006801:Humans; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D011634:Public Health; D009927:Tissue and Organ Procurement / Q000191:economics / Q000941:ethics / Q000706:statistics & numerical data; D014850:Waiting Lists
keywords: death dying and bereavement; health policy; profession and professionalization; research methodology; technology in health care